Giving Compass' Take:

• Philip Setel shares six insights into successfully advocating for civil registration and vital statistics for policymaking. 

• How can funders advance the collection and use of this data? 

• Read about using data for community development. 

In 2007, a group of researchers and I wrote about the “scandal of invisibility” of unregistered births and deaths affecting millions of people, especially in low- and middle-income countries. In the years since, this problem has become more widely known as people more deeply understood the importance of civil registration and vital statistics (CRVS) to sound public policy. This culminated in 2015, when the United Nations (UN) set ambitious Strategic Development Goal (SDG) targets to provide legal identity, including 100 percent birth registration and 80 percent death registration by 2030.

To guide the efforts of advocates for strong CRVS systems, here are six insights from recent work funded by Bloomberg Philanthropies, the World Bank, the Centre of Excellence in CRVS, and others:

1. Coordination among government agencies can expedite progress. CRVS systems are by nature complex. Their ownership is usually distributed across not only a country's registration authority, but also ministries of health, justice, interior, and national statistics. Experience has shown that effective national steering committees produce the best results when comprised of these stakeholders, including one entity, perhaps the president or prime minister’s office, possessing the clear authority to convene the committee.

2. An improved legal and regulatory environment sets the groundwork for widespread impact. A CRVS system derives its legitimacy from a set of laws and regulations. This legal framework charters it as the sole foundational means to establish legal identity for citizens and residents. That, in turn, is the basis for access to protections and entitlements. In some countries, CRVS legal frameworks date from the colonial era and have little relevance to contemporary human rights or the needs of modern states to collect data using information technology.

3. Bringing client-friendly registration services closer to the people can increase registration numbers. Inquiries into low registration completeness have revealed that barriers such as distance to registration offices and limited office hours have discouraged many from registering vital events. Many registration systems in low-income countries, such as Bangladesh, Rwanda, and Tanzania, have historically placed the burden on families to travel long distances to register a vital event at an authorized office or registrar, which are often located in city centers. However, making offices more accessible through large expansions of brick and mortar locations can prove both time consuming and costly.

4. Partnerships with hospitals lead to more accurate and accessible reporting of births and deaths. In most countries, the health sector represents the single largest potential source of data on births and deaths and the best, if not only, source of cause-of-death data. But in many low- and middle-income countries, hospitals have rarely taken active steps to ensure the formal registration of vital events occurring within their walls, leaving this task to parents and surviving family members. To address this issue, Rwanda in 2019 required its government hospitals to register births, deaths, and causes of death; today, more than 80 percent of deaths occurring in health facilities are registered through the civil registrar at their premises. In Ghana, the Ministry of Health and the Registrar General began sharing data on vital events in 2018.

5. Conducting verbal autopsies yields new insights on community cause of death patterns. In countries where most deaths occur outside of the hospital setting, verbal autopsies—interviews with surviving family members about the deceased—should be routinely conducted. This is the only way to reliably determine community patterns of mortality in such settings. The purpose of the verbal autopsy is to identify the leading causes of death at the population level. Because establishing and maintaining a verbal autopsy system is complex, it is optimal to use a representative population sample large enough to yield reliable national or sub-national estimates and small enough to effectively manage.

6. Embracing technology can allow for easier data collection and speedier analysis. Advances in technology make it possible to count every human life, even people in remote areas. In Peru, digital certification of cause of death is approaching 100 percent in 370 hospitals sharing a national information network. The data are automatically assigned a WHO mortality code and analyzed for use in policy and program decision making. This has led to better consistency and quality of death certificates and made data available to policy makers in weeks, not years.

Read the full article about civil registration and vital statistics by Philip Setel at Stanford Social Innovation Review.